Pub Date : 2023-10-22DOI: 10.17650/1818-8338-2023-17-2-k688
S. M. Markin, S. V. Grishin, A. S. Artemova
The era of the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) virus has shown that non-core specialists can be involved in the treatment of epidemic diseases. However, the entire burden for the prevention and treatment of venous thromboembolism (VTE) falls on doctors – cardiovascular surgeons, phlebologists. It should be borne in mind that most of the thromboses – more than 2 million cases per year – are asymptomatic, and only a small part has pulmonary embolism, pulmonary hypertension, and death. The survival rate of patients with deep vein thrombosis (DVT) for 8 years is 65 %, with a combination of DVT with pulmonary embolism; the survival rate does not exceed 34 %, so a doctor of any specialty should know how to suspect VTE. The clinical picture of DVT is not always pronounced. Most often, with DVT, patients complain of swelling and pain in the affected lower limb, a decrease in the volume of active movements, and skin cyanosis. Diagnosis of DVT and thromboembolic complications at the non-specialized level should initially consist of assessing the risk of VTE using special scales, among which the Wales scale is of the greatest importance. The gold standard for diagnosing DVT is duplex ultrasound. Among the main indicators for hospitalization is not the fact of the established diagnosis of DVT, but the presence of comorbid pathology, chronic lung diseases, and old age. Additional risk factors include extended DVT, suspected pulmonary embolism, and pregnancy. The goal of anticoagulant therapy is to stop the process of pathological hypercoagulability, the progression of thrombus formation and create conditions for restoring vascular patency, while the pathological idea is that anticoagulants “dissolve the thrombus”. In this regard, anticoagulant therapy is the mainstay of treatment for DVT. To determine the duration of anticoagulant therapy, the etiology of thrombosis is of particular importance – the trigger that led to the formation of thrombotic masses.
{"title":"What should a general practitioner know about the management of patients with venous thromboembolism?","authors":"S. M. Markin, S. V. Grishin, A. S. Artemova","doi":"10.17650/1818-8338-2023-17-2-k688","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-2-k688","url":null,"abstract":"The era of the Severe Acute Respiratory Syndrome CoronaVirus 2 (SARS-CoV-2) virus has shown that non-core specialists can be involved in the treatment of epidemic diseases. However, the entire burden for the prevention and treatment of venous thromboembolism (VTE) falls on doctors – cardiovascular surgeons, phlebologists. It should be borne in mind that most of the thromboses – more than 2 million cases per year – are asymptomatic, and only a small part has pulmonary embolism, pulmonary hypertension, and death. The survival rate of patients with deep vein thrombosis (DVT) for 8 years is 65 %, with a combination of DVT with pulmonary embolism; the survival rate does not exceed 34 %, so a doctor of any specialty should know how to suspect VTE. The clinical picture of DVT is not always pronounced. Most often, with DVT, patients complain of swelling and pain in the affected lower limb, a decrease in the volume of active movements, and skin cyanosis. Diagnosis of DVT and thromboembolic complications at the non-specialized level should initially consist of assessing the risk of VTE using special scales, among which the Wales scale is of the greatest importance. The gold standard for diagnosing DVT is duplex ultrasound. Among the main indicators for hospitalization is not the fact of the established diagnosis of DVT, but the presence of comorbid pathology, chronic lung diseases, and old age. Additional risk factors include extended DVT, suspected pulmonary embolism, and pregnancy. The goal of anticoagulant therapy is to stop the process of pathological hypercoagulability, the progression of thrombus formation and create conditions for restoring vascular patency, while the pathological idea is that anticoagulants “dissolve the thrombus”. In this regard, anticoagulant therapy is the mainstay of treatment for DVT. To determine the duration of anticoagulant therapy, the etiology of thrombosis is of particular importance – the trigger that led to the formation of thrombotic masses.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"148 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135464274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-22DOI: 10.17650/1818-8338-2023-17-2-k686
O. S. Levin, E. E. Vasenina, A. I. Nebozhin, A. Yu. Nikitina
Back pain constitutes one of the major medico-social problems of healthcare. The development of a unified approach to the diagnosis and treatment of back pain is hindered since it is difficult to assess the various approaches to its treatment, especially its chronic forms. Yet recent data witnessing the important role of the neuroinflammatory process in the pathogenesis of the degenerative forms of discopathy suggest that the traditional treatment approach, which includes physical therapy exercises and non-steroidal anti-inflammatory drugs and myorelaxants, could be enhanced by using drugs characterized by slow structure-modifying action on the structure of the cartilaginous tissue of intervertebral discs and joints. Given the intelligent use of manual therapy, needle reflex therapy, kinesiotherapy, as well as modification of psychosocial factors that pre-determine the yellow flag phenomenon, the application of sustained-release symptomatic drugs increases the efficacy of therapy and prevents subsequent pain episodes. As of today, a placebo-controlled study has proven the action of Alflutop, which can be administered both intramuscularly and paravertebrally. This approach not only improves the patients’ condition but also reduces the burden associated with chronic back pain problems for the society.
{"title":"Treatment algorithm for chronic vertebrogenic back pain: the role of chondroprotectors","authors":"O. S. Levin, E. E. Vasenina, A. I. Nebozhin, A. Yu. Nikitina","doi":"10.17650/1818-8338-2023-17-2-k686","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-2-k686","url":null,"abstract":"Back pain constitutes one of the major medico-social problems of healthcare. The development of a unified approach to the diagnosis and treatment of back pain is hindered since it is difficult to assess the various approaches to its treatment, especially its chronic forms. Yet recent data witnessing the important role of the neuroinflammatory process in the pathogenesis of the degenerative forms of discopathy suggest that the traditional treatment approach, which includes physical therapy exercises and non-steroidal anti-inflammatory drugs and myorelaxants, could be enhanced by using drugs characterized by slow structure-modifying action on the structure of the cartilaginous tissue of intervertebral discs and joints. Given the intelligent use of manual therapy, needle reflex therapy, kinesiotherapy, as well as modification of psychosocial factors that pre-determine the yellow flag phenomenon, the application of sustained-release symptomatic drugs increases the efficacy of therapy and prevents subsequent pain episodes. As of today, a placebo-controlled study has proven the action of Alflutop, which can be administered both intramuscularly and paravertebrally. This approach not only improves the patients’ condition but also reduces the burden associated with chronic back pain problems for the society.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135464273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-22DOI: 10.17650/1818-8338-2023-17-2-k682
S. Yu. Mukhtarenko, T. M. Murataliev, Z. T. Rajapova
Aim. To study gender characteristics of affective disorders (prevalence and severity of anxiety and depression) and quality of life in patients with coronary heart disease (CHD) according to screening and psychometric tests. Materials and methods. Five hundred seventy six patients with a verified diagnosis of CHD were tested using the Screening Questionnaire for Affective Spectrum Disorders (SQASD): 385 (67.8 %) men and 191 (33.2 %) women. From the total screening group using, 383 patients were examined with the Beck Depression Inventory (BDI), while examination with the hospital anxiety and depression scale (HADS) included 351 patients with CHD. The quality of life index was determined in 242 patients with CHD using the Modified Seattle Angina Questionnaire (SAQ). Results. In the general group of patients with CHD examined by SQASD, anxiety and depressive disorders (ADD) were diagnosed in 81 %, the absence of ADD – in 19 %, p < 0.0001. In the group of patients examined using SQASD and the BDI scale, the presence of ADD was noted in 78.9 %, the absence – in 21.1 %, p < 0.0001. Screening of patients examined with the BDI scale revealed higher incidence of ADD in women: 95 % vs. 71.5 %, p < 0.0001. The overall score on the HADS anxiety scale in the men’s group was 7.9 ± 4.7, in the women’s group – 10.28 ± 3.9, p < 0.0001, while according the HADS depression scale – 6.32 ± 3.92 and 7.7 ± 4.18, respectively, p < 0.004. The level of depression by BDI scale in the men’s group was 14.07 ± 9.82, in the women’s group – 17.75 ± 8.42, p < 0.0004. Absence of symptoms of depression according the BDI scale was observed more often in the group of men compared with the group of women: 36.9 % and 19.2 %, p < 0.0005. The frequency of severe anxiety (45.8 % and 28.7 %, p < 0.002) and depression (26.2 % and 11.5 %, p < 0.0004) according the HADS was higher in the group of women compared to the group of men. The value of the IUCN quality of life index was higher in the group of men (25.4 ± 7.1 and 22.4 ± 4.8, p < 0.001). Conclusion. In this study, screening of CHD patients using SQASD and psychometric tests (BDI and HADS) has revealed higher incidence of ADD and psychosocial risk factors (anxiety and depression) in the group of women compared with the group of men. The results of screening are generally consistent with the survey data of psychometric tests and QOL indicators.
{"title":"Gender specifics of affective disorders in patients with coronary heart diseas (according to screening and psychometric tests)","authors":"S. Yu. Mukhtarenko, T. M. Murataliev, Z. T. Rajapova","doi":"10.17650/1818-8338-2023-17-2-k682","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-2-k682","url":null,"abstract":"Aim. To study gender characteristics of affective disorders (prevalence and severity of anxiety and depression) and quality of life in patients with coronary heart disease (CHD) according to screening and psychometric tests. Materials and methods. Five hundred seventy six patients with a verified diagnosis of CHD were tested using the Screening Questionnaire for Affective Spectrum Disorders (SQASD): 385 (67.8 %) men and 191 (33.2 %) women. From the total screening group using, 383 patients were examined with the Beck Depression Inventory (BDI), while examination with the hospital anxiety and depression scale (HADS) included 351 patients with CHD. The quality of life index was determined in 242 patients with CHD using the Modified Seattle Angina Questionnaire (SAQ). Results. In the general group of patients with CHD examined by SQASD, anxiety and depressive disorders (ADD) were diagnosed in 81 %, the absence of ADD – in 19 %, p < 0.0001. In the group of patients examined using SQASD and the BDI scale, the presence of ADD was noted in 78.9 %, the absence – in 21.1 %, p < 0.0001. Screening of patients examined with the BDI scale revealed higher incidence of ADD in women: 95 % vs. 71.5 %, p < 0.0001. The overall score on the HADS anxiety scale in the men’s group was 7.9 ± 4.7, in the women’s group – 10.28 ± 3.9, p < 0.0001, while according the HADS depression scale – 6.32 ± 3.92 and 7.7 ± 4.18, respectively, p < 0.004. The level of depression by BDI scale in the men’s group was 14.07 ± 9.82, in the women’s group – 17.75 ± 8.42, p < 0.0004. Absence of symptoms of depression according the BDI scale was observed more often in the group of men compared with the group of women: 36.9 % and 19.2 %, p < 0.0005. The frequency of severe anxiety (45.8 % and 28.7 %, p < 0.002) and depression (26.2 % and 11.5 %, p < 0.0004) according the HADS was higher in the group of women compared to the group of men. The value of the IUCN quality of life index was higher in the group of men (25.4 ± 7.1 and 22.4 ± 4.8, p < 0.001). Conclusion. In this study, screening of CHD patients using SQASD and psychometric tests (BDI and HADS) has revealed higher incidence of ADD and psychosocial risk factors (anxiety and depression) in the group of women compared with the group of men. The results of screening are generally consistent with the survey data of psychometric tests and QOL indicators.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135462280","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-21DOI: 10.17650/1818-8338-2023-17-2-k683
E. V. Grigoryeva, D. A. Tyapkina, A. A. Boroday, I. S. Blokhin, I. E. Kondrashkin, M. A. Polidanov, A. P. Rebrov
Aim. To study the features of the course of COVID-19 in pregnant women, the outcomes of a new coronavirus infection and pregnancy, the effect of concomitant pathology on the severity of the course and the frequency of complications of COVID-19. Materials and methods. In the course of the work, a retrospective analysis of 109 medical histories of pregnant women who were treated in the infectious diseases department in 2021 with a diagnosis of COVID-19 was carried out. Anamnesis, concomitant pathology, results of objective examination, laboratory and instrumental methods of research, therapy, complications, outcomes of COVID-19 and pregnancy were evaluated. Results. The majority of pregnant women had moderate – 55 % and severe – 24 % COVID-19, 7 % – extremely severe and only 14 % – mild. A third of pregnant women had concomitant pathology, arterial hypertension was the most common; 80 % of pregnant women had complications of COVID-19: cytokine storm – in 50 % of patients, acute respiratory distress syndrome – in 17 %, of which 5 % required artificial lung ventilation. The mortality rate was 4.6 %. The structure of pregnancy complications was dominated by gestational hypertension, gestational diabetes, premature placental abruption, preeclampsia. Complications of childbirth – premature birth and premature discharge of amniotic fluid. However, in most cases, pregnancy (75 %) and childbirth (71 %) proceeded without complications. Women in 95 % of cases were discharged from the hospital with recovery or significant clinical improvement. Conclusion. Despite the prevalence of moderate and severe forms of COVID-19 in pregnant women, a high percentage of concomitant pathology and complications, in most cases favorable outcomes of both COVID-19 and pregnancy were noted. The presence of hypertension syndrome should probably be considered as a prognostically unfavorable marker of severe course and adverse outcomes of COVID-19 in pregnant women.
{"title":"Features of the course of COVID-19 in pregnant women","authors":"E. V. Grigoryeva, D. A. Tyapkina, A. A. Boroday, I. S. Blokhin, I. E. Kondrashkin, M. A. Polidanov, A. P. Rebrov","doi":"10.17650/1818-8338-2023-17-2-k683","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-2-k683","url":null,"abstract":"Aim. To study the features of the course of COVID-19 in pregnant women, the outcomes of a new coronavirus infection and pregnancy, the effect of concomitant pathology on the severity of the course and the frequency of complications of COVID-19. Materials and methods. In the course of the work, a retrospective analysis of 109 medical histories of pregnant women who were treated in the infectious diseases department in 2021 with a diagnosis of COVID-19 was carried out. Anamnesis, concomitant pathology, results of objective examination, laboratory and instrumental methods of research, therapy, complications, outcomes of COVID-19 and pregnancy were evaluated. Results. The majority of pregnant women had moderate – 55 % and severe – 24 % COVID-19, 7 % – extremely severe and only 14 % – mild. A third of pregnant women had concomitant pathology, arterial hypertension was the most common; 80 % of pregnant women had complications of COVID-19: cytokine storm – in 50 % of patients, acute respiratory distress syndrome – in 17 %, of which 5 % required artificial lung ventilation. The mortality rate was 4.6 %. The structure of pregnancy complications was dominated by gestational hypertension, gestational diabetes, premature placental abruption, preeclampsia. Complications of childbirth – premature birth and premature discharge of amniotic fluid. However, in most cases, pregnancy (75 %) and childbirth (71 %) proceeded without complications. Women in 95 % of cases were discharged from the hospital with recovery or significant clinical improvement. Conclusion. Despite the prevalence of moderate and severe forms of COVID-19 in pregnant women, a high percentage of concomitant pathology and complications, in most cases favorable outcomes of both COVID-19 and pregnancy were noted. The presence of hypertension syndrome should probably be considered as a prognostically unfavorable marker of severe course and adverse outcomes of COVID-19 in pregnant women.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"32 3","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135513572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-21DOI: 10.17650/1818-8338-2023-17-2-k680
O. V. Dobrovolskaya, N. V. Demin, A. Yu. Feklistov, M. V. Kozyreva, N. V. Toroptsova
Aim. To evaluate skeletal muscle mass, muscle strength and physical performance in rheumatoid arthritis (RA) women with biological therapy. Materials and methods. The study included 63 women (average age 60.3 ± 8.9 years) with confirmed RA treated with biological therapy and 117 age-matched RA patients who had never previously treated with biological therapy. Clinical and laboratory examination, evaluation of body composition using dual-energy X-ray densitometry and tests to assess muscle strength and physical performance were carried out. Results. The frequency of sarcopenic phenotype among RA patients was 23.3 %: in those who received biological medication – 27.0 %, in the control – 21.4 % (p > 0.05). There were no differences between the groups based on the results of muscle strength assessment tests, however, patients on biological therapy performed significantly better the short physical performance battery (SPPB) and had a higher walking speed (p = 0.016 and p = 0.002, respectively). Univariate linear regression analysis confirmed the relationship of the presence of biological therapy with the functional status of the muscles according to the results of SPPB (b* = 0.24; p = 0.018) and walking speed (b* = 0.28; p = 0.006). Conclusion. The frequency of sarcopenic phenotype among patients with RA was 23.3 % and was comparable in those who received biological therapy and without it. There were no differences in muscle strength depending on the presence of biological therapy, but the functional status of skeletal muscles was significantly better in women who received such treatment.
{"title":"Sarcopenic phenotype and functional status of skeletal muscles in rheumatoid arthritis patients with biological therapy","authors":"O. V. Dobrovolskaya, N. V. Demin, A. Yu. Feklistov, M. V. Kozyreva, N. V. Toroptsova","doi":"10.17650/1818-8338-2023-17-2-k680","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-2-k680","url":null,"abstract":"Aim. To evaluate skeletal muscle mass, muscle strength and physical performance in rheumatoid arthritis (RA) women with biological therapy. Materials and methods. The study included 63 women (average age 60.3 ± 8.9 years) with confirmed RA treated with biological therapy and 117 age-matched RA patients who had never previously treated with biological therapy. Clinical and laboratory examination, evaluation of body composition using dual-energy X-ray densitometry and tests to assess muscle strength and physical performance were carried out. Results. The frequency of sarcopenic phenotype among RA patients was 23.3 %: in those who received biological medication – 27.0 %, in the control – 21.4 % (p > 0.05). There were no differences between the groups based on the results of muscle strength assessment tests, however, patients on biological therapy performed significantly better the short physical performance battery (SPPB) and had a higher walking speed (p = 0.016 and p = 0.002, respectively). Univariate linear regression analysis confirmed the relationship of the presence of biological therapy with the functional status of the muscles according to the results of SPPB (b* = 0.24; p = 0.018) and walking speed (b* = 0.28; p = 0.006). Conclusion. The frequency of sarcopenic phenotype among patients with RA was 23.3 % and was comparable in those who received biological therapy and without it. There were no differences in muscle strength depending on the presence of biological therapy, but the functional status of skeletal muscles was significantly better in women who received such treatment.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"98 24","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135513573","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-10-20DOI: 10.17650/1818-8338-2023-17-2-k681
E. V. Ovchinnikova, N. A. Schneider, A. A. Ovchinnikova, R. F. Nasyrova
Introduction. Despite modern advances in diagnostic technologies, the problem of Wilson (WD) disease prevalence remains relevant in the world; clinical and scientific interest in epidemiological studies varies in the Russian Federation and in different countries. The aim. To study the prevalence of WD in the population of the Russian Federation and foreign countries at the present stage. Materials and methods. The paper presents an analysis of the results of domestic and foreign epidemiological studies of WD published in the eLibrary, Google Scholar, PubMed, Springer, Scopus, Elsevier, Oxford Press, Clinical Case, Cochrane, Science Direct databases from January 01, 2018 to June 01, 2023 year. Results. In total, 14 epidemiological studies were analyzed. In the countries of North and South America, the prevalence of WD is from 4.1 per 100,000, up to 6.4 per 100,000 and in European countries from 1.44 per 100,000 to 9.0 per 100,000, in Asian countries – from 1.793 per 100,000 to 4.81 per 100,000. Conclusion. Results of epidemiological studies prevalence of WD depended on design and methodology: with using the method of genetic screening of the population for WD, the prevalence rates were much higher and reached 40 per 100,000 in Europe, 19.6 in Asia due to detection of early stages of disease development (asymptomatic forms).
{"title":"Prevalence of hepatolenticular degeneration in different countries","authors":"E. V. Ovchinnikova, N. A. Schneider, A. A. Ovchinnikova, R. F. Nasyrova","doi":"10.17650/1818-8338-2023-17-2-k681","DOIUrl":"https://doi.org/10.17650/1818-8338-2023-17-2-k681","url":null,"abstract":"Introduction. Despite modern advances in diagnostic technologies, the problem of Wilson (WD) disease prevalence remains relevant in the world; clinical and scientific interest in epidemiological studies varies in the Russian Federation and in different countries. The aim. To study the prevalence of WD in the population of the Russian Federation and foreign countries at the present stage. Materials and methods. The paper presents an analysis of the results of domestic and foreign epidemiological studies of WD published in the eLibrary, Google Scholar, PubMed, Springer, Scopus, Elsevier, Oxford Press, Clinical Case, Cochrane, Science Direct databases from January 01, 2018 to June 01, 2023 year. Results. In total, 14 epidemiological studies were analyzed. In the countries of North and South America, the prevalence of WD is from 4.1 per 100,000, up to 6.4 per 100,000 and in European countries from 1.44 per 100,000 to 9.0 per 100,000, in Asian countries – from 1.793 per 100,000 to 4.81 per 100,000. Conclusion. Results of epidemiological studies prevalence of WD depended on design and methodology: with using the method of genetic screening of the population for WD, the prevalence rates were much higher and reached 40 per 100,000 in Europe, 19.6 in Asia due to detection of early stages of disease development (asymptomatic forms).","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"10 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135665491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2021-01-26DOI: 10.17650/1818-8338-2020-14-3-4-K630
O. Andropova
Cardiovascular diseases are the leading cause of disability, premature mortality and economic loss worldwide. Despite the proven effectiveness of preventive measures in reducing the risks of development and progression of cardiovascular diseases, these programs are the most difficult to implement. 75–90 % of visits to primary care physicians in Western Europe and the United States are associated with physical fatigue and stress disorders, back pain and injuries. Studies have shown that workers with risk factors for chronic noncommunicable diseases are often absent from the workplace, have a higher level of disability and lower labor productivity. A worker with depression costs the employer almost 1,5 times more expensive than people without diseases. Elevated glucose levels, arterial hypertension, smoking and obesity cause an increase in the employer’s medical expenses by 34,8; 31,6; 31 and 27,4 %, respectively. The cost of US employers to pay for medical services, to compensate for the absence or ineffective presence due to illness costs $ 200 billion annually – more than $ 1,500 per employee. The health of workers is determined by both risk factors specific to the workplace and general population and individual risks..Modern technologies of health management, changing the profile of the health of labor collectives, can improve the image of the employer and increase the profitability of companies. The return on investment in corporate health programs is from 3 to 10 US dollars for each dollar invested. The programs implemented at the enterprises of the Russian Federation made it possible to reduce the duration of diseases with disability by 20–30 %, reduce mortality and the initial exit to disability by 45–60 %. The widespread introduction of the most effective corporate wellbeing programs of workers in the activities of medical organizations and companies of various profiles will ensure the implementation of the national projects “Healthcare” and “Demography”.
{"title":"Health management: fashion trend or promising investment? Overview of corporate health promotion programs","authors":"O. Andropova","doi":"10.17650/1818-8338-2020-14-3-4-K630","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-3-4-K630","url":null,"abstract":"Cardiovascular diseases are the leading cause of disability, premature mortality and economic loss worldwide. Despite the proven effectiveness of preventive measures in reducing the risks of development and progression of cardiovascular diseases, these programs are the most difficult to implement. 75–90 % of visits to primary care physicians in Western Europe and the United States are associated with physical fatigue and stress disorders, back pain and injuries. Studies have shown that workers with risk factors for chronic noncommunicable diseases are often absent from the workplace, have a higher level of disability and lower labor productivity. A worker with depression costs the employer almost 1,5 times more expensive than people without diseases. Elevated glucose levels, arterial hypertension, smoking and obesity cause an increase in the employer’s medical expenses by 34,8; 31,6; 31 and 27,4 %, respectively. The cost of US employers to pay for medical services, to compensate for the absence or ineffective presence due to illness costs $ 200 billion annually – more than $ 1,500 per employee. The health of workers is determined by both risk factors specific to the workplace and general population and individual risks..Modern technologies of health management, changing the profile of the health of labor collectives, can improve the image of the employer and increase the profitability of companies. The return on investment in corporate health programs is from 3 to 10 US dollars for each dollar invested. The programs implemented at the enterprises of the Russian Federation made it possible to reduce the duration of diseases with disability by 20–30 %, reduce mortality and the initial exit to disability by 45–60 %. The widespread introduction of the most effective corporate wellbeing programs of workers in the activities of medical organizations and companies of various profiles will ensure the implementation of the national projects “Healthcare” and “Demography”.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"14 1","pages":"29-35"},"PeriodicalIF":0.0,"publicationDate":"2021-01-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48642232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-08DOI: 10.17650/1818-8338-2020-14-1-2-62-72
В. Н. Кандилова
The aim of the study evaluation of the structural and functional changes of the heart and common carotid arteries (CCA) in patients with AH I–III degree with the definition of significant criteria for their remodeling in patients with the absence and presence of accompanying obesity (OB) of varying degrees. Materials and methods . 124 patients (86 men and 38 women) aged 27 to 81 years (average age 55.7 ± 1.01 years) were examined. In 19 of them (12 men and 7 women) AH of I degree, in 87 (65 men and 22 women) II degree AH, in 18 (9 men and 9 women) III degree AH was diagnosed. The diagnosis of AH and its degree was verified in accordance with the existing current clinical guidelines (European Society of Hypertension / European Society of Cardiology’s, 2013). Clinical-anamnestical and instrumental examination of patients were carried out with the assessment of their reflection of myocardial remodeling in accordance with the recommendations. Availability and degree of concomitant OB was carried out in accordance with the calculated body mass index and recommended gradations. Echocardiographic examination, ultrasound scanning were used to study the heart and CCA on both sides and reactive hyperemia test used for studying a number of parameters reflecting the remodeling of myocardium and arteries. Laboratory examination included determination of the main parameters of blood plasma lipid profile. The data analysis was carried out with the help of Statistica 12.6 application package. Results . Patients with AH and concomitant OB have a number of differences in the heart and arteries compared to patients with AH without OB. Heart: increased size and volume, myocardial mass, myocardial mass index, decreased contractility and more frequent detection of diastolic dysfunction of the left ventricle of the heart. Arteries: increase in thickness of the intimamedia complex, decrease in intraadventitial diameter of the right and left common carotid arteries, more frequent detection of endothelial vasomotor function impairment using the right brachial artery as an example. The analysis of the obtained data confirmed the presence of significant remodeling of the cardiovascular system (CVS) in patients with AH, which is dependent on the presence and degree of concomitant OB: a more pronounced progress in remodeling of the heart and arteries was observed in some patients with AH with concomitant OB, partly dependent on the degree of the latter and, apparently, associated with hormonal changes that lead to an acceleration of processes underlying the formation of CVS remodeling. Conclusion . The combination of AH with OB of different degrees leads to an increase in the frequency of cases of remodeling of the CVS as a whole in comparison with patients with AH without accompanying OB, with changes in the lipid profile of the blood at the accompanying AH OB of different degrees characterized by an increase in its atherogenic fractions, exacerbated with the increase in the
本研究旨在评估Ⅰ-Ⅲ度 AH 患者心脏和颈总动脉（CCA）的结构和功能变化，并确定在没有和存在不同程度肥胖（OB）的患者中，心脏和颈总动脉重塑的重要标准。材料和方法 .研究对象为 124 名患者（86 名男性和 38 名女性），年龄在 27 至 81 岁之间（平均年龄为 55.7 ± 1.01 岁）。其中 19 人（12 名男性和 7 名女性）被诊断为 I 度 AH，87 人（65 名男性和 22 名女性）被诊断为 II 度 AH，18 人（9 名男性和 9 名女性）被诊断为 III 度 AH。AH的诊断及其程度是根据现行的临床指南（欧洲高血压学会/欧洲心脏病学会，2013年）核实的。根据建议对患者进行了临床分析和仪器检查，并对其心肌重塑的反映进行了评估。根据计算得出的体重指数和建议的分级，对患者是否患有并发肺结核以及并发肺结核的程度进行了评估。超声心动图检查和超声扫描用于研究心脏和两侧的 CCA，反应性充血试验用于研究反映心肌和动脉重塑的一系列参数。实验室检查包括血浆脂质概况主要参数的测定。数据分析在 Statistica 12.6 软件包的帮助下进行。结果 .与没有卵巢癌的卵巢癌患者相比，患有卵巢癌的患者在心脏和动脉方面有许多不同之处。心脏：体积和容积增大，心肌质量和心肌质量指数增加，收缩力下降，左心室舒张功能障碍更频繁地被发现。动脉：内膜复合体厚度增加，左右颈总动脉内径减小，以右肱动脉为例，更频繁地发现内皮血管运动功能受损。对所获数据的分析证实，AH 患者的心血管系统（CVS）存在明显的重塑，这与是否存在并发 OB 以及 OB 的程度有关：在一些并发 OB 的 AH 患者中，可以观察到心脏和动脉的重塑进展更为明显，这部分取决于后者的程度，而且显然与激素变化有关，激素变化导致心血管系统重塑形成的基础过程加速。结论 .与不伴有 OB 的 AH 患者相比，伴有不同程度 OB 的 AH 会导致整个 CVS 重塑病例的发生率增加，伴有不同程度 AH 的 OB 患者的血脂状况会发生变化，其特征是致动脉粥样硬化部分增加，并随着 OB 程度的增加而加剧。
{"title":"Ремоделирование сердца и сосудов при артериальной гипертензии: роль сопутствующего ожирения","authors":"В. Н. Кандилова","doi":"10.17650/1818-8338-2020-14-1-2-62-72","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-62-72","url":null,"abstract":"The aim of the study evaluation of the structural and functional changes of the heart and common carotid arteries (CCA) in patients with AH I–III degree with the definition of significant criteria for their remodeling in patients with the absence and presence of accompanying obesity (OB) of varying degrees. Materials and methods . 124 patients (86 men and 38 women) aged 27 to 81 years (average age 55.7 ± 1.01 years) were examined. In 19 of them (12 men and 7 women) AH of I degree, in 87 (65 men and 22 women) II degree AH, in 18 (9 men and 9 women) III degree AH was diagnosed. The diagnosis of AH and its degree was verified in accordance with the existing current clinical guidelines (European Society of Hypertension / European Society of Cardiology’s, 2013). Clinical-anamnestical and instrumental examination of patients were carried out with the assessment of their reflection of myocardial remodeling in accordance with the recommendations. Availability and degree of concomitant OB was carried out in accordance with the calculated body mass index and recommended gradations. Echocardiographic examination, ultrasound scanning were used to study the heart and CCA on both sides and reactive hyperemia test used for studying a number of parameters reflecting the remodeling of myocardium and arteries. Laboratory examination included determination of the main parameters of blood plasma lipid profile. The data analysis was carried out with the help of Statistica 12.6 application package. Results . Patients with AH and concomitant OB have a number of differences in the heart and arteries compared to patients with AH without OB. Heart: increased size and volume, myocardial mass, myocardial mass index, decreased contractility and more frequent detection of diastolic dysfunction of the left ventricle of the heart. Arteries: increase in thickness of the intimamedia complex, decrease in intraadventitial diameter of the right and left common carotid arteries, more frequent detection of endothelial vasomotor function impairment using the right brachial artery as an example. The analysis of the obtained data confirmed the presence of significant remodeling of the cardiovascular system (CVS) in patients with AH, which is dependent on the presence and degree of concomitant OB: a more pronounced progress in remodeling of the heart and arteries was observed in some patients with AH with concomitant OB, partly dependent on the degree of the latter and, apparently, associated with hormonal changes that lead to an acceleration of processes underlying the formation of CVS remodeling. Conclusion . The combination of AH with OB of different degrees leads to an increase in the frequency of cases of remodeling of the CVS as a whole in comparison with patients with AH without accompanying OB, with changes in the lipid profile of the blood at the accompanying AH OB of different degrees characterized by an increase in its atherogenic fractions, exacerbated with the increase in the","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"17 10","pages":"62-72"},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141205930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-08DOI: 10.17650/1818-8338-2020-14-1-2-14-23
A. Aksenova, D. V. Abeldyaev, E. Glushkova
Epidemiological situation related to the spread of streptococcal infection and post-streptococcal diseases in the world remains tense in recent decades. According to the World Health Organization, more than 616 million cases of streptococcal pharyngitis occur annually in the world. Group A Streptococcus (GAS) is the most common cause of morbidity and mortality in infectious diseases and one of the main human pathogens. The prevalence of severe cases of GAS infections amounted to 18.1 million people worldwide. At the same time, in recent years outbreaks of scarlet fever have been recorded in some countries. In 2011, scarlet fever rate was 10 times higher than the average rate of the previous decade. In the past 3 years, epidemics of scarlet fever have been registered in the UK, with an increased incidence every year. Although there are significant achievements in the fight against rheumatic fever (RF), it keeps reminding of itself in the form of new outbreaks. Currently, acute rheumatic fever (ARF) is not a mass disease, but it is a serious problem associated with heart damage. In the article, we analyzed incidence and prevalence of RF, rheumatic heart disease (RHD), chronic pharyngitis, nasopharyngitis, sinusitis and rhinitis. We present the comparative characteristic among children, adolescents and adults. We also describe high epidemiological and social significance of the problem and possible increase of RF and RHD, which cause significant social and economic damage, remaining the urgent problem of public health in Russia. It was revealed that the situation with ARF and RHD in Russia remains unstable. Between 1997 and 2016, epidemiological indicators of streptococcal infection tend to increase moderately. ARF incidence significantly increases with an average growth rate (AGR) of 2.5 %, while its prevalence has the opposite tendency to decrease. AGR was –29.2 %. RFD incidence showed a significant indicators increase with AGR of +1.1 %. At the same time, the prevalence tended to decrease and STP was –2 %. The situation makes it necessary to strengthen the epidemiological control of streptococcal infection and increase the alertness of doctors regarding the new cases of ARF and RHD.
{"title":"Current epidemiological aspects of streptococcal and poststreptococcal diseases in the Russian Federation","authors":"A. Aksenova, D. V. Abeldyaev, E. Glushkova","doi":"10.17650/1818-8338-2020-14-1-2-14-23","DOIUrl":"https://doi.org/10.17650/1818-8338-2020-14-1-2-14-23","url":null,"abstract":"Epidemiological situation related to the spread of streptococcal infection and post-streptococcal diseases in the world remains tense in recent decades. According to the World Health Organization, more than 616 million cases of streptococcal pharyngitis occur annually in the world. Group A Streptococcus (GAS) is the most common cause of morbidity and mortality in infectious diseases and one of the main human pathogens. The prevalence of severe cases of GAS infections amounted to 18.1 million people worldwide. At the same time, in recent years outbreaks of scarlet fever have been recorded in some countries. In 2011, scarlet fever rate was 10 times higher than the average rate of the previous decade. In the past 3 years, epidemics of scarlet fever have been registered in the UK, with an increased incidence every year. Although there are significant achievements in the fight against rheumatic fever (RF), it keeps reminding of itself in the form of new outbreaks. Currently, acute rheumatic fever (ARF) is not a mass disease, but it is a serious problem associated with heart damage. In the article, we analyzed incidence and prevalence of RF, rheumatic heart disease (RHD), chronic pharyngitis, nasopharyngitis, sinusitis and rhinitis. We present the comparative characteristic among children, adolescents and adults. We also describe high epidemiological and social significance of the problem and possible increase of RF and RHD, which cause significant social and economic damage, remaining the urgent problem of public health in Russia. It was revealed that the situation with ARF and RHD in Russia remains unstable. Between 1997 and 2016, epidemiological indicators of streptococcal infection tend to increase moderately. ARF incidence significantly increases with an average growth rate (AGR) of 2.5 %, while its prevalence has the opposite tendency to decrease. AGR was –29.2 %. RFD incidence showed a significant indicators increase with AGR of +1.1 %. At the same time, the prevalence tended to decrease and STP was –2 %. The situation makes it necessary to strengthen the epidemiological control of streptococcal infection and increase the alertness of doctors regarding the new cases of ARF and RHD.","PeriodicalId":30685,"journal":{"name":"Klinicist","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67772467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-05-08DOI: 10.17650/1818-8338-2020-14-1-2-62-72
В. Н. Кандилова
The aim of the study evaluation of the structural and functional changes of the heart and common carotid arteries (CCA) in patients with AH I–III degree with the definition of significant criteria for their remodeling in patients with the absence and presence of accompanying obesity (OB) of varying degrees. Materials and methods . 124 patients (86 men and 38 women) aged 27 to 81 years (average age 55.7 ± 1.01 years) were examined. In 19 of them (12 men and 7 women) AH of I degree, in 87 (65 men and 22 women) II degree AH, in 18 (9 men and 9 women) III degree AH was diagnosed. The diagnosis of AH and its degree was verified in accordance with the existing current clinical guidelines (European Society of Hypertension / European Society of Cardiology’s, 2013). Clinical-anamnestical and instrumental examination of patients were carried out with the assessment of their reflection of myocardial remodeling in accordance with the recommendations. Availability and degree of concomitant OB was carried out in accordance with the calculated body mass index and recommended gradations. Echocardiographic examination, ultrasound scanning were used to study the heart and CCA on both sides and reactive hyperemia test used for studying a number of parameters reflecting the remodeling of myocardium and arteries. Laboratory examination included determination of the main parameters of blood plasma lipid profile. The data analysis was carried out with the help of Statistica 12.6 application package. Results . Patients with AH and concomitant OB have a number of differences in the heart and arteries compared to patients with AH without OB. Heart: increased size and volume, myocardial mass, myocardial mass index, decreased contractility and more frequent detection of diastolic dysfunction of the left ventricle of the heart. Arteries: increase in thickness of the intimamedia complex, decrease in intraadventitial diameter of the right and left common carotid arteries, more frequent detection of endothelial vasomotor function impairment using the right brachial artery as an example. The analysis of the obtained data confirmed the presence of significant remodeling of the cardiovascular system (CVS) in patients with AH, which is dependent on the presence and degree of concomitant OB: a more pronounced progress in remodeling of the heart and arteries was observed in some patients with AH with concomitant OB, partly dependent on the degree of the latter and, apparently, associated with hormonal changes that lead to an acceleration of processes underlying the formation of CVS remodeling. Conclusion . The combination of AH with OB of different degrees leads to an increase in the frequency of cases of remodeling of the CVS as a whole in comparison with patients with AH without accompanying OB, with changes in the lipid profile of the blood at the accompanying AH OB of different degrees characterized by an increase in its atherogenic fractions, exacerbated with the increase in the
本研究旨在评估Ⅰ-Ⅲ度 AH 患者心脏和颈总动脉（CCA）的结构和功能变化，并确定在没有和存在不同程度肥胖（OB）的患者中，心脏和颈总动脉重塑的重要标准。材料和方法 .研究对象为 124 名患者（86 名男性和 38 名女性），年龄在 27 至 81 岁之间（平均年龄为 55.7 ± 1.01 岁）。其中 19 人（12 名男性和 7 名女性）被诊断为 I 度 AH，87 人（65 名男性和 22 名女性）被诊断为 II 度 AH，18 人（9 名男性和 9 名女性）被诊断为 III 度 AH。AH的诊断及其程度是根据现行的临床指南（欧洲高血压学会/欧洲心脏病学会，2013年）核实的。根据建议对患者进行了临床分析和仪器检查，并对其心肌重塑的反映进行了评估。根据计算得出的体重指数和建议的分级，对患者是否患有并发肺结核以及并发肺结核的程度进行了评估。超声心动图检查和超声扫描用于研究心脏和两侧的 CCA，反应性充血试验用于研究反映心肌和动脉重塑的一系列参数。实验室检查包括血浆脂质概况主要参数的测定。数据分析在 Statistica 12.6 软件包的帮助下进行。结果 .与没有卵巢癌的卵巢癌患者相比，患有卵巢癌的患者在心脏和动脉方面有许多不同之处。心脏：体积和容积增大，心肌质量和心肌质量指数增加，收缩力下降，左心室舒张功能障碍更频繁地被发现。动脉：内膜复合体厚度增加，左右颈总动脉内径减小，以右肱动脉为例，更频繁地发现内皮血管运动功能受损。对所获数据的分析证实，AH 患者的心血管系统（CVS）存在明显的重塑，这与是否存在并发 OB 以及 OB 的程度有关：在一些并发 OB 的 AH 患者中，可以观察到心脏和动脉的重塑进展更为明显，这部分取决于后者的程度，而且显然与激素变化有关，激素变化导致心血管系统重塑形成的基础过程加速。结论 .与不伴有 OB 的 AH 患者相比，伴有不同程度 OB 的 AH 会导致整个 CVS 重塑病例的发生率增加，伴有不同程度 AH 的 OB 患者的血脂状况会发生变化，其特征是致动脉粥样硬化部分增加，并随着 OB 程度的增加而加剧。
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